Centered on Health 3-27-25 - Use of robotics and their benefits in joint replacement surgeries with Dr. Alex Sweet.
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Speaker 1 (00:01):
It's now time for Centered on Hell with Baptists Hell
on use Radio. Wait forty tell many WYJS. Now here's
doctor Jeff Tubblin.
Speaker 2 (00:11):
Good evening and welcome to tonight's episode of Set It
on Hell with Baptist Hell Here on News Radio eight
forty whas. I'm your host, Doctor Jeff Tubblin, and we're
joined as always from the studio by our producer, mister
Jim Fentn. He is waiting for you to call in
and talk to tonight's expert. And our phone number is
five oh two, five seven one eight four eighty four
(00:34):
if you want to call in five oh two, five
seven one eight four eight four. So seven hundred and
ninety thousand total knee replacements are done in the United
States every year, and five hundred and forty four thousand
hit replacements as well, So we're very lucky that our
guest tonight is an expert in both of those surgeries.
So doctor Alex Sweet is joining us tonight. He's an
(00:56):
orthopedic surgeon in Louisville, Kentucky, affiliated with Baptist hig Hospital.
He performs minimally invasive surgery for the knee and the hip,
and he is a wealth of information and experience.
Speaker 3 (01:06):
He has been on our show before. We always learn so.
Speaker 2 (01:10):
Much from from him. Welcome doctor Sweet, and welcome back
to Center on Health.
Speaker 1 (01:15):
Thank you very much for having me.
Speaker 3 (01:17):
Yeah, we love having you.
Speaker 2 (01:19):
It's such a it's such an important surgery that people
have to have and think about. And you know, you
are no stranger to the world of orthopedics, having coming
from a tradition of orthopedic surgeons in near family. So
tell us a little bit, like, my kids want nothing
to do with anything that I went into. So how
did that click for you? What made you want to
follow and become an orthopedic surgeon?
Speaker 1 (01:42):
I think you know, uh, children of physicians and either
goes one of two ways. Either they you know, grow
up loving the idea of being a doctor and that's
the only thing they could ever do, or they grew
up hating it. And you know, some of it's probably
the kid, and some of it's probably a lot of
the mother or father that was the physician. And you know,
(02:02):
first of all, my dad loved his job. You know,
he never worked a day in his life because he
absolutely loved what he did. And second of all, probably
the only thing my dad was better at the knee
and hip surgery was being a father and he was
just always there and always around. And I think just
having that experience and seeing the love he had for
the job, it's what I wanted to do.
Speaker 3 (02:22):
Well, that's a great answer.
Speaker 2 (02:25):
So we're going to try and cover both the hip
and the knee tonight, and we're going to try and
get as much information out of you obviously as we can.
But I want to start with the hip. So tell
us a little bit about the hip and the anatomy
that we might need to understand to know what you're
doing with the replacement and the function, and you know
what the hip is supposed to be doing.
Speaker 1 (02:46):
Sure, So, I mean the hip kind of comes down
to being a ball and socket joint. And what happens
is the cartilage, which is on the end of the
bone on both the ball and on the socket, starts
to wear out over time. And most people think it's
like a wear and tear thing, but honestly, it's more
genetic than anything else. If your mom, dad, grandparents all
(03:07):
had arthritis, you're gonna have it too. And so as
that starts to wear out and the bone underneath starts
to get exposed that has nerve endings and that's painful,
and that's the grinding feeling that people get and it's
what causes all the pain. But centered around the hip
is a bunch of important ligaments, tendons, muscles. There's you know,
(03:28):
a cluster of muscles we call the short external rotators
that kind of help twist your leg in and out.
There's the gluteal muscles, you know, gluteaus maximus, medius minimus
that are kind of your your big butt muscles. Then
there's you know, the hip flexor muscles what allow you
to you know, pick your thigh up, you know, your
your quadrcep muscles. Even so, all these muscles are around
(03:50):
the hip joint and it's it's a deep structure. It's
it's well in between all of these muscles, nerves, tendons, ligaments.
So it's a it's a complex join for sure in
terms of the soft tissue anatomy.
Speaker 2 (04:03):
And how do most people present when they have a
hip issue. Is it like not able to move the hip?
Speaker 1 (04:10):
Is it pain?
Speaker 3 (04:11):
What do you see?
Speaker 1 (04:11):
Most commonly, it's pain with weight bearing and activity. You know,
classically the pain is in the groin kind of in
the what I tell people is front pocket pain is
usually the hip. Back pocket pain is usually your back,
and so that's kind of a rule of thumb. But
certainly not everyone reads the anatomy book, and some people
present differently, but it's usually yeah, pain right in the groin.
Speaker 3 (04:34):
Fantastic.
Speaker 2 (04:35):
Well, I will say I I want to stick with
the hip, but we actually have a caller already, so
I don't want to have him miss the opportunity to
talk to you. So we have got David on the
phone and he has a question about his knee and
kind of having bone on bone, so maybe you can
tell us a little bit about what that means. Also,
but David, you're on Centered on Health with doctor sweet.
Speaker 1 (04:56):
Well, thank you very much. Doctor Peln.
Speaker 4 (04:59):
Yes, I have boom both in my knees, and right
now I'm experiencing a whole lot of pain and I
can't be operated on because they want me to lose
weight and it's very difficult to do and you could
barely walk it in pain. So I've heard about gail treatments,
and I'm wondering, is that the official to someone who
(05:20):
has bone on bone or is that I'm not beyond
that particular kind of treatment.
Speaker 1 (05:26):
So you know, jel's a difficult one to tackle, right
because you know, you see them advertised a lot. You know,
they're on TV, they're everywhere. I mean, truthfully, I gave
a couple of people gel injections today in my clinic.
I am not a big fan of Gael injections, and
I'll tell you why. When we study gel injections, they
(05:50):
do not do very well. And so when we take
you know, a few thousand people and half of them
get a GEL shot and half of them get a
shot of water in their knee, and we don't tell
them which one they're getting, and the person giving the
shot doesn't even know what they're getting it. So that's
called a double blinded trial. That's the best kind of
trial we can do. And when we do that, there's
no difference between the water shot and the jail shot.
(06:13):
So these things are incredibly lucrative. You know, I get
a little you know, with everything, and I get a
little fee for giving the procedure given a shot, but
I make way more off of the gel itself. The
medication is incredibly lucrative, and that's that's the real impetus
behind all the advertisement that you see. So I always
tell people that if I give someone a jail shot,
I'll let them know this, and if they still want
(06:35):
to proceed, I think it's fine. And I think for
some people where they just don't have any other options.
You know, maybe you're overweight, you have a medical issue,
or you're just terrified a surgery and want to try everything.
It's not dangerous and if your insurance will pay for it,
you know, the only risk is you get it and
it doesn't work, which is certainly a lower risk than
having surgery and that not working, there's something going wrong.
(06:55):
So I always respect the patient's autonomy and ability to choose.
But gel shots are not a you know, they're not
something that works on a regular basis for most people.
Speaker 5 (07:06):
Okay, well, thank you very much.
Speaker 1 (07:07):
That was very helpful. I appreciate it very much.
Speaker 3 (07:10):
Yeah, thank you for calling in and being a part
of our show.
Speaker 1 (07:13):
Than before.
Speaker 3 (07:15):
Yeah, have a great have a great rest of your night.
Speaker 2 (07:17):
So, doctor Sweep, before we take a first commercial, let
me just piggyback on that whole topic. This This was
obviously a bone on bone issue, But before somebody gets
to that point, what do you feel about the supplements
out there, conjoint and things like that. Do you use
that or are those things that can help people symptomatically?
Speaker 1 (07:36):
You know, there's never been any evidence to show that
those things work. You know, they're a little for most people,
they're a little expensive out of pocket, you know, Biomechanically,
it doesn't make a whole lot of sense that those
would actually you know, be you know, metabolized and turn
into new cartilage. But another thing that's completely harmless, right,
You're not gonna it's not like a vitamin you're gonna
(07:58):
take too much of. It's not un if it doesn't
have interactions with blood pressure medicines or other medicines. So
it's very safe. And I've got some patients that take
them and swear it works for them. And you know,
just because the studies don't show a difference doesn't mean
it doesn't help a particular population of people. And especially
when it's safe, I think it's always fine to try.
Speaker 2 (08:19):
And when it says bone on bone, how does somebody
get that?
Speaker 3 (08:24):
What leads to a bone on bone? What are we
kind of talking about?
Speaker 1 (08:28):
Well, that just means the cartilage on both ends, either
the hip or the knee, has worn out and so
the bone is just literally grinding on the bone, and
that's usually when the pain starts to worsen. But you know,
I've got patients that get corzone shots or gel shots
or just do physical therapy and live with it and
have had bone on bone for years and do just fine.
Other people gets to be bone on bone becomes debilitating.
(08:50):
So it's more about the patient and their symptoms other
than the actually.
Speaker 2 (08:54):
Fantastic Well, we do have another caller, but I'm going
to ask them to hold on just a little bit
because we're going to take a quick break. We are
talking tonight with doctor Alex Sweet about knee replacements and
hip replacements. This is doctor Jeff Tublin. You are listening
to Senate on Health with Baptist Health here on news
radio eight forty wh as. Our phone number five oh
(09:15):
two five seven one eight four eighty four. That's five
oh two, five seven one eight four eight four. We'll
see you at the break at the end of the break.
(09:42):
Welcome back to Centate It on Health with Baptist Health
here on news radio eight forty WHS. I'm your host,
doctor Jeff Tublin. We're talking tonight with doctor Alex Sweet
about knee replacement surgeries and hip replacement surgeries and any
any questions related to that. Our phone number is five
oh two one four. Our producer, mister Jim Fenn is
(10:04):
already taking and ready to take your calls. So welcome back,
doctor Sweet. We've got several callers who are ready to
hear your expertise, and we're gonna start with the first one.
We have Warren on the phone. Who Wallace on the phone,
who is asking a question about a knee replacement Wallece,
are you with us?
Speaker 5 (10:24):
Yes? Thank you doctors. Uh yeah, I've Brett injured my
knee like thirty eight years ago and now it has
severe tried compartmental arthritis with the big ol'd Baker syst
But I've been missing a ligament all that time, interior cruciate.
When and if I had the total knee replacement or
(10:45):
would any surgeon consider trying to do something with that
missing ligament to add stability? Are there any options during
knee replacement to address still missing ACL?
Speaker 1 (11:01):
So so here here's the truth about new arthritis. Even
if you hadn't torn your ACL, when you get really
bad ne arthritis, your ACL is usually torn. Anyways, or
kind of non functional knee replacement designs. Almost all of them,
We're talking about ninety nine point nine percent of the
ones put in the United States and Europe. They are
(11:22):
all designed to not have an ACL. So when I
do my knee replacements, I cut out the ACL. So, uh,
it is a structure that actually gets in the way.
You end up cementing the tibia implant right over top
of where the ACL and search. So that is a
fortunately for you, a complete non factor.
Speaker 5 (11:41):
Okay, what about a Baker says that you have to
kind of live with that.
Speaker 1 (11:46):
So a Baker's syst is a symptom, it's not actually
the problem. What happens is the knee is is basically
a water balloon, right, it holds the oil in that
lubricates the knee. And if the knee keeps swelling up
because it's painful and arthritic, that fluid has to go
somewhere and the weak spots in the back so it
kind of creates this out poushing back there called a
Baker cyst. So when you replace the knee, yeah, you
(12:08):
still got a Baker's syst. I mean, your knee is
big and swollen, it's painful, could just add surgery and
as it starts to heal, and as there's no more
reason for the knee to swell, that Baker's cyst resolves
on its own.
Speaker 5 (12:21):
Okay, well, thank you so much.
Speaker 2 (12:24):
Well, thank you thanks for being a part of the show.
And if Mike is still on the line, then Mike
has a question for you, I switching gears into the
hip about different types of hip surgery. Mike, are you
on the line, yes, wonderful, Well, welcome to Senate on
Hell and you have doctor sweet.
Speaker 1 (12:43):
Hey.
Speaker 6 (12:44):
Is it true that you prefer the anterior approach for
the hip versus the posterior approach for patient outcome and recovery?
Speaker 1 (12:54):
I do you know, there's been a lot of studies
on this. It's basically been shown that the anterior hip
has a quicker recovery, you know, long term. Is there
a big difference? Not really. Probably the biggest difference is
the anterior hip has a little bit lower dislocation rate
where the ball will not pop out of the socket
(13:16):
to the same degree. You know, a lot of surgeons
there's a learning curve to learning it, and so like
I learned the anterior hip in my residence, so I
kind of started day one with it, but when it
was becoming popular, some surgeons didn't want to switch over,
and like my father never switched over. He did, you know,
post your hip to the end of his career. It's
(13:36):
just a little bit different of a surgery. You have
to detach some tendons, you're cutting through your biggest gluteal muscle,
and so the recovery is a little bit tougher because
of that. Okay, thank you, thanks thanks for calling in.
Speaker 2 (13:52):
So since we've been doing a little bit of knee stuff,
I want to ask you a couple of questions that
actually got submitted to me. The first one is, if
you're seeing a rise in knee injuries in younger athletes
with some of the use of these more synthetic feels
and artificial turf, Is that like a real thing? Are
(14:13):
you seeing more injuries because of that?
Speaker 1 (14:16):
So I'll be honest, I am not, because I mean
the joke is I'm kind of a geriatric orthopedis right.
I mean, you know, I see forty fifty year olds
with arthritis, but I'm not seeing the college athlete out
on the synthetic turf because if they tear their acl
I don't fix that. You know, I'm a knee and
hip replacement specialist, and so if they tear their ACL
(14:37):
thirty years later, they may need my services, but for
now they're going to my partners. But there are absolutely
some synthetic turfs that have been shown to increase the
rate of LIGAMENTUS, knee injuries and other injuries.
Speaker 2 (14:51):
Great, and we have another caller on the line, which
is Terry. If Terry is with us, Terry, are you
on the line?
Speaker 3 (14:58):
Yes, I am, well, Welcome to the show.
Speaker 2 (15:01):
Welcome to Centered on Health. You have a doctor, sweet
and it sounds like you have a question about a hip, right.
Speaker 7 (15:09):
I wondered somebody told me that I had pain in
my hips, and I was worried it was going to
be a replacement situation. But then somebody said it could
be birthsidas. And I just want to ask the doctor
what are the symptoms of versidis because mine is sort
of on the side and it goes down to where
you know, the I call them the saddle bags on
(15:31):
your legs are Yeah, does if any help for me
on that?
Speaker 1 (15:37):
Sure? So you know, trying to diagnosis over the phone.
If you made me pick, I'll tell you that probably
is presidas, so I kind of said earlier. Hip arthritis
is front pocket pain. Back pocket pain is back pain,
usually pain on the side of the hip, right on
the side. That's usually presidas. Now sometimes also means tendon itis.
But what it is a non operative issue and a
(15:59):
lot of times the zone shot in there or some
physical therapy can help you a lot.
Speaker 7 (16:05):
Where should I go for a court of zone shot?
Should I go to an orthopeutic person?
Speaker 1 (16:09):
Or yeah? Probably tomorrow morning. So I'm happy to see
you and take Carrie.
Speaker 7 (16:18):
Okay, and how do you spell your last name? I'm
sorry I couldn't understand it.
Speaker 1 (16:23):
S W E E t oh.
Speaker 7 (16:26):
Okay, that's sweet?
Speaker 1 (16:27):
All right, easy enough, right, Yeah, you're very sweet.
Speaker 2 (16:32):
Bye, Terry, thank you for calling and thanks for being
a part of the show.
Speaker 3 (16:36):
And good luck.
Speaker 2 (16:36):
Sounds like hopefully we may be able to avoid surgery
for you. That's great.
Speaker 1 (16:41):
I've had your status before. It hurts.
Speaker 2 (16:43):
Yeah, it is painful. Well, hopefully a COURTI zone shot
will will help. Uh so, doctor sweet. There was some
news this week about one of the women n C
double A athletes, Juju Watkins, who j A C L
And I mean it was such a such an unfortunate thing.
Can you can you tell us is there a difference
(17:03):
in injury to what female athletes and male athletes. Is
the anatomy different. I had read a couple of things
that suggested that, yeah.
Speaker 1 (17:13):
There is some truth to it. So actually, when I
was in my residency, my chief year, my one of
my co residents, she actually studied this and back when
she was in med school and was did a presentation
on it. There's a lot of difference. There's there's some
anatomic differences based on anatomy of the pelvis. Actually, women
(17:35):
have slightly different pelvises, which means their femur or their
thigh bone comes in in a different angle. And because
of that angle, it changes the angle of the knee
where the where the shin bone meets the femur bone.
There's also differences in the strength of the quatercep versus
the hamstring, and women tend to have a little bit
(17:55):
of dominance of their quadtercep over the hamstring, and that
and that, and it's can actually lead to injury during
landing in a higher rate of ACL pairs. So that
that was the data on this about you know, ten
years ago. Now there may have been something to change.
But again, as a knee replacement surgeon, that's not you know,
the focus of my career. But there is a real difference.
Speaker 2 (18:18):
Wow, that's that's that's fascinating. So you mentioned a little
bit about the cortisone injection, and just to kind of
you know, round out that that advice. How often can
somebody get a steroid injection? Is there like a limit
on how much steroid you can give somebody in terms
of an injection or is there a certain frequency that's allowed.
(18:40):
What what do you see and how how long do
they need to get it typically for it to be effective.
Speaker 1 (18:46):
When we're talking about like joint pain, you know, there's
no real limitation. I mean, sometimes you're talking about something
in the hand or foot and ankles, sometimes there's limitations.
You can have one or two and that's it. But
if you're talking about just ne arthritis, hip arthritis is
getting core zone injections or preside us, there's no limit.
I mean the limit it ends when when it is
no longer effective in the treatment. And so eventually the
(19:10):
disease gets bad enough that the corizone shot just doesn't
work or doesn't last very long, and then you've got
to consider surgery at that point, and you can get
it every three months.
Speaker 3 (19:21):
Every three months, well, that's good.
Speaker 2 (19:24):
And then when you how do you advise people to decide,
you know, hey, I think it's time I need surgery, Like,
what's that? What's the tipping point that either you typically
see patients come to or a patient might be thinking
at home. I've tried this, I've tried that, maybe I
really need to think about having surgery, you.
Speaker 1 (19:44):
Know, except in rare circumstances where sometimes patients need some reassurance.
My goal is to never talk someone into a surgery, right,
So I tell them they will know, and that's the truth.
And you know, I get multiple people coming into my
office every day that says that say, either myself or
my dad or someone else told them they were going
to need a knee replacement and they would know, and
(20:05):
they go, I know, I'm ready, and then we have
the conversation. You know, eventually it starts inhibiting your life,
and it depends on what that is. I mean, some
people right now pickleballs in Some people say, you know,
I'm get in these court zone shots. I can't play pickleball.
I love pickleball. I want to keep playing on what
my neighborplace other people. I can't even get to the mailbox.
My knee is so bad. I'm in a wheelchair and
(20:25):
now I'm ready. And so it's individual rights. It's not
certain metrics for certain people. It's you got to treat
the patient holistically, not just you know, a spreadsheet of
what you can and can't do.
Speaker 2 (20:39):
And when a patient is evaluating a surgeon, what's a
good number for a year of someone doing these that
somebody should be looking for to say, hey, you know this,
this practitioner does a lot of these, And is there
a number per year that you think makes somebody kind
of more in that expert area.
Speaker 1 (21:01):
I think if you're I think if you're doing you know,
two to three hundred neighbor replacements a year, you're in
kind of that higher you start to begin be getting
into that higher volume category where it's it's been shown
in the literature that the complication rates are lower, patient
satisfaction scores are higher. So that's the number I usually
give people somewhere between two and three hundred a year.
Speaker 2 (21:21):
Fantastic, Well, we are learning all about me and hip
surgery tonight. We are talking with doctor Alex Sweet. We're
going to take a quick break here. I want to
remind everybody that you are listening to Centered on Health
with Doctor's Health here on news Radio eight forty whas.
I'm your host, doctor Jeff Tublin, and our phone number
is five oh two, five seven one, eight four eight
(21:42):
four if you want to call in and there's still
time to ask questions, we'll be right back. LL welcome
(22:02):
back everyone to Center It on Health with Doctor's Health
here on news Radio eight forty whas. I'm your host,
doctor Jeff Tublin. And if you aren't just joining us,
we are talking tonight with doctor Alex Sweet, who is
an orthopedic surgeon here in Louisville with specialties in both
knee and hip. And we've been answering lots of great
questions and picking his brain with a lot of great questions.
Speaker 3 (22:25):
So I do want to take a moment.
Speaker 2 (22:28):
Doctor Sweet, to focus a little specifically on the knee
and your practice, because I know that you are our
next generation of orthopedic surgeons and are using a lot
of newer techniques with your surgeries. Talk to us a
little bit about especially since you have the perspective with
your Dad, How have things evolved and what are you
(22:49):
doing that's kind of unique with knees.
Speaker 1 (22:54):
Yeah, So I think as technology keeps evolving, we keep
finding ways to bring it into healthcare and improve outcomes.
You know, the knee replacement kind of traditionally we you know,
it's more of like instead of a replacement, think of
it as resurfacing where you're just cutting a little bit
of the bone and cartilage up the end and capping
it with some metal and there's a plastic shin that
(23:16):
goes in between. And so traditionally the angles of the
cut just kind of get determined by your bone, by
your femur and your tiviot. But the problem is what
really matters are your ligaments. How tight your ligament on
the inside your MCL, how loose the ligament on the
outside your LCL is And in some people it's the
it's vice versa. The relationship is switched. And you can
(23:39):
gain some insight into that based on preoperative X ray
or MRI, but you can't know until you get in
the knee. And so what we used to do is
cut the bone, put in the implants, and then kind
of cut the ligaments to match what we did to
the knee and it works. Okay, it does, but it's
it's not a perfect surgery. And so with the ad
(24:00):
of robotics, what we're now able to do is before
we cut any bone, we can actually tension the ligaments,
find out exactly how much give and take they all have,
and then design the implant to go in the perfect
orientation to match your ligaments. So we're not talking about
some huge difference. We're talking about one, two, three degrees here,
(24:20):
you know, half a millimeters millimeter there. But the clinical
difference is monumental in terms of not having to release
the ligaments at all. And so robotics is changing knee
replacement quickly.
Speaker 2 (24:35):
And the advantage of the ligament thing is that you
don't have to cut them, or their healing is faster,
or what is the clinical advantage there?
Speaker 1 (24:45):
So a it's a better long term result because when
you balance the knee appropriately, patients have less instability, less pain,
faster recovery, and the long term outcome is better. You know,
if you put a knee in just you know, at
ninety degrees to the bone and throw a piece of
plastic in there, the knee is going to wobble around
a fair amount, and it's going to lead to increased
(25:07):
pain and patient dissatisfaction. You know, traditionally knee replacements can
have up to twenty percent patient dissatisfaction score. There's a
lot of things that lead to that, but one of
the things that we're using to combat that is robotics
and it's made a huge den Well that's great.
Speaker 2 (25:24):
And do you see things coming down the line. Are
we kind of at our peak with it or do
you see things changing even in the next five to
ten years.
Speaker 1 (25:34):
Oh? No, I think we're continuing to evolve. I mean
I'm starting to use some augmented reality with the surgery
to help interface with the robot, you know, to kind
of overlay it over the patient and make that process
a little more seamless. So no, I mean technology is
always changing, and you know, I always want to make
sure we're not just bringing unnecessary technology in that it's safe,
(25:55):
that there's a reason to do it and not just
to you know, for the next shiny tour way. But no,
there there are clear advancements in technology that are that
are benefiting surgeries.
Speaker 2 (26:08):
That's fantastic. And how long does need replacement? Last is
do you get one and your good or is there
a life expectancy where someone might have to have it
done again.
Speaker 1 (26:20):
Yeah, with everything, there's a life expectancy. I tell my
patients it's a car tire, and it depends on the
size of the car, and it depends on the speed
of the car. You know, Grandma's olds will bile is
going to last a whole lot longer than you know,
fifty year old's Ferrari. And so depending on the wear
and tear you put on it, you can wear it
out either the cement that bonds it, the plastic in between.
(26:43):
Something can wear out over time. You know, the rule
of thumb we give people is twenty years. The stuff
we're using now is better. In twenty years from now,
we'll know how it's how well it's lasting. But at
least twenty.
Speaker 2 (26:54):
Plus years, I mean that's yeah, that's a good amount
of time. And when when some one has a knee replacement,
how do you tell them to expect that they're going
to feel in terms of their ability to do things?
Is the expectation that they will be like they were
before their knee ever gave them problems? Or can they
(27:16):
tell that they have a knee replacement by like hearing
it or feeling it, Like how do you have the
conversation about what life with the knee replacement will be?
Speaker 1 (27:24):
Like part of that depends on what the patient's expectations
are and you kind of have to delve down into
what they do. Are they looking to get back to
playing full court basketball? Are they looking to be able
to you know, get to you know, Friday afternoon, you know,
par cheesy with their friends and not have any knee pain.
And once you find out what the expectations are, you
can really tailor it to them. I mean, you know,
(27:46):
for the higher demand patients, patients wanted to get back
to basketball, tennis, you know, walk the golf course. You know.
I tell them it's never going to be in need.
That feels like you're twenty years old again. It's always
going to be replaced. It's always going to be a
little bit foreign. But it shouldn't give you any pain
and it should allow you to do all the things
you want to do without pain. And that's the big thing.
Speaker 3 (28:08):
And how long is the surgery?
Speaker 2 (28:11):
How long is the hospital stay? And when do you
get them starting on rehab?
Speaker 1 (28:20):
So the surgery is you know, an hour a little less,
little more, just kind of depends on the patient and everything.
But the surgery time a little less than an hour
a hospital. Say, you know, some patients are a candidate
to go home the same day, Some need to stay
at night, some patients still need to go to rehab
for a little while. In terms of getting them up,
(28:41):
once their eyes are open, it's time to get to work.
It's immediate. You know, we get them up right away,
get them working with physical therapy. You know, they can
have home therapy for a week or two, then sooner
you get the outpatient therapy, the better. Your home does
not have a pet department, and so you need all
the equipment. We're getting extra special exercise bikes delivered to
(29:01):
the house. Talking about technology, these are special engineered exercise
bikes where the pedals kind of barely moved and they
start moving more and more. I get multiple patients a
day telling me what an awesome piece of equipment it is,
and it really is. Got an interactive screen kind of
walks them through how to do everything. So it's an
(29:21):
immediate go, go go. In terms of getting to the.
Speaker 2 (29:24):
Rehab and what's a typical rehab program, I'm sure it
varies from person to person based on their progress, but
on average, how long does it take for people to
be through the physical therapy and then kind of be
out on their own again.
Speaker 1 (29:40):
You know, first three weeks are tough. It's not an
easy surgery. And everyone that's going through it has a
friend or someone that's gone through it and they tell
them that, so they come in knowing that those first
few weeks they're really tough and there's a reason we
get pain medicine for it. And once they get through that,
it gets a whole lot better. You know, by six
eight weeks you should be getting around pretty well. We
call it three months to recover. But the biggest key
(30:02):
to being happy with your need is understanding even at
three months, you're not as good as you're gonna get.
And it takes about a year for the need to
feel as natural and normal as it's going to. And
not that you can't get out and do stuff and
you can't get back to golf or you can't get
back to these things, but it's just it's not as
good as it will be.
Speaker 2 (30:20):
Well, I can appreciate two things that you said there.
I mean one is and they're both really about expectations,
And I think, you know, the way you describe the
healing process is really important because you know, I think
we all know people that have these done and just
like you said, they think they're going to be back
to doing things immediately, and if they're not, that that
means that they won't continue to get to get better.
Speaker 3 (30:41):
So that's that's great.
Speaker 2 (30:44):
What do you see, like, are there things that we
should be doing in our lives before our neees become
a problem that might keep us out of the operating room?
Speaker 1 (30:56):
You know, you really can't prevent arthritis like the disease itself.
You know, staying active. The old adage motion is lotion
is really important. You know, people to become debilitated have
way more pain. You know, when your quad step and
your muscles are on the legs start getting weak, it
hurts more. The other thing is your knee sees three
(31:18):
times your body weight when you walk, five times when
you do the stairs, and seven times when you squat,
So if you get it from a chair, your body's
seeing seven times your body weight. And if you're three
hundred pounds and you're supposed to be two hundred, that
means that's seven hundred pounds each knee is seeing extra
when you get up from the seat of position, so.
Speaker 2 (31:36):
That that's a big deal. That is an interesting perspective. Yes, well,
let's take our final break here. We're going to get
back to hips when we come back, and we'll remind
everybody that you are listening to Centered on Health with
Baptis Health here on news radio eight forty whas. We're
talking tonight with doctor Alex Sweet, orthopedic surgeon here in Louisville,
(31:58):
about hip and knee replacement. And if you've missed any
part of tonight's show or you want to hear all
this information, download the iHeartRadio app. It's free, it's easy
to use, and it gives you access to all of
tonight's information.
Speaker 3 (32:10):
We'll be right back.
Speaker 2 (32:24):
Welcome back to Centered on Help with Baptist Help here
on news radio eight forty WATS. I'm your host, doctor
Jeff Tomlin, and we're talking tonight with doctor Alex Sweet,
who's an orthopedic surgeon here in Louisville. He's talking to
us about knee replacements and hip replacements. Remember to download
the iHeartRadio app to re listen to this or any
of our previous segments and to have access to all
(32:46):
the other features that they have app cuts to offer. So,
Doctor Sweet, I've been trying to get back to the
hip and I'm going to do it. So I want
to hear a little bit about the hip. Earlier on
in the show when we first started talking about the hippie,
we're talking about out a ball and socket, and could
you just expand on that and tell us a little
bit about what is actually getting replaced in a hip replacement.
Speaker 1 (33:10):
Sure, So when we do the surgery, we actually remove
the ball and so the ball is attached to the
femur or your thigh bone. And right after we kind
of get the ball out of the way, we look
up into the cup and we have these circular reamers
that basically bore out a perfectly circular hole in that cup,
(33:30):
just expand it by a millimeter or two, and then
we put a metallic cup up into the into the socket,
and usually we'll use a you know, a forty five
millimeter reamer and then a forty six millimeter cup and
the cup kind of wedges in because it's one millimeter larger,
and then there's a plastic liner that then snaps into
(33:51):
that metal cup and at that point you're done with
the cup side. Now on the femur, there's a stem
that goes down into the thigh bone, and so we
actually have to make room for that. You know, the
the bone bone is is hollow. On the outside is
the hard cortical bone, and on the inside is this
softer can sell us bone. And we kind of have
(34:13):
to dig that softer bone out so that the implant
rests right on the harder bone. That way, it doesn't
you know, slip down or what we call subside or
slip down the femur, because when we put it in,
we want it to be we want it to stay
at that same place and not move. And so we've
got all these devices that kind of, you know, remove
that bone little by little, and you keep going up
on the size until you get one that fits perfectly
(34:36):
on the on the cortex of the bone. And then
there's different trials where you can change the length of
the ball in its relationship to the stem so that
you can equalize the leg length to kind of dial
it in perfectly. And one of the reasons I love
the interior hip is I can bring in an X
ray get a perfect a perfect X ray and measure
those leg links and make sure we're bound it in perfectly.
(34:58):
And then you put the real femur part in with
the real ball. You pop it back in, get a bilelectray,
make sure it looks good. And that's kind of what's
being replaced. The nice thing with the anterior hip. I
don't have to detach a single ligament and I don't
have to be touch a sea. I don't have to
cut a single muscle. I can literally take my finger
and dissect between the muscles bluntly and get down to
(35:19):
the hip castle.
Speaker 3 (35:21):
And does that that decreases pain or recovery or both both?
Speaker 1 (35:27):
Yeah, a little a little bit less pain. I mean,
hip replacements typically not a very painful surgery, especially when
you compare it to a knee, but it absolutely helps
with the recovery time more than anything. Got it?
Speaker 3 (35:40):
And what is the term like a partial hip replacement?
What does that mean?
Speaker 1 (35:46):
So you know there's partial knees, there's partial hips. Partial
knees a great surgery for a young, active individual with
archritis and part of their knee. A partial hip is
something that gets done by essentially a non joints someone
that does not typically perform hip replacements like full hip
replacements when someone breaks their hip, So a partial is
(36:08):
not something we do for elective hip arthritis. It's done
for someone that falls down, breaks their hip and needs surgery.
You know, typically when that happens and I'm on call,
or the patient that ends up in my hands, I'll
do a full hip replacement. But some of my patients,
some of my colleagues that you know are more adept
at ACL surgery and not so much knee and hip replacement,
(36:29):
will do a partial hip and those patients still do
very well with that.
Speaker 2 (36:34):
And you know, I'm assuming, you know, other than trauma,
which obviously would have you know, potentially only affect one side.
Do most people, if they get problems in their hip,
get them in both hips and ultimately need both hips replaced?
Or do you find that some people just get arthritis
in one hip and they never have a problem with
the other hip.
Speaker 1 (36:56):
It tends to run in both. They don't always, you know,
not everyone comes in with both hips being in stage
our frights. Sometimes it's just one and then years later
it's the other. I can't tell you how many patients
I've replaced one of their hips and my Dad replaced
their other hip ten fifteen, twenty years ago, so it's
incredibly variable when they present, but if you live long enough,
(37:20):
it tends eventually get there.
Speaker 3 (37:22):
If you have it in one, you'll probably have it
in the other.
Speaker 1 (37:25):
Yes, got it.
Speaker 2 (37:27):
And we've talked a lot about rehab, which I think
most people are familiar with, but there's been this concept
of sort of prehab. Is that something that you use
in your practice, sending people for strengthening and stuff before
the surgery, and what's the thought behind that process?
Speaker 1 (37:45):
So I love it. I love the idea of it.
The idea of prehab is essentially going to physical therapy
before the surgery to strengthen yourself up. Well that help
with your postof recovery. Absolutely. Probably the biggest issue is
how many physical therapy appointments you get in the calendar years.
So it's a limitation of physical therapy. And so if
(38:08):
if you're about to the knee replacement, your insurance says
you're gonna have fifteen physical therapy appointments and you use
six of them before surgery, you're gonna you're gonna be
struggling afterwards. You're either gonna have to pay out of pocket,
or you're gonna have to do it on your own,
and that's hard. So it's great when I talk about patients, Yeah,
if I'm gonna if they're gonna do it, I'll usually
tell them, hey, go once, learn the exercises and do
(38:30):
them on your own so you don't run out of therapy.
Speaker 3 (38:33):
Oh, that's that's great advice.
Speaker 2 (38:35):
And then also I think people hear a lot about
like platelet rich plasma. Is that something I know we've
talked about it before, and I've talked to other guests
on the show that you know, sometimes it helps before surgery,
maybe not, But are you using it as part of
your surgery?
Speaker 1 (38:54):
I am not. It's a complete out of pocket expense
with absolutely no literature to suppor it for knee and
hip arthritis. There's some limited evidence in other fields, but
in terms of the knee and hip, there's no real
evidence that it helps. And I just I don't want
to charge my patients that kind of money for that.
Speaker 2 (39:11):
Great And then you talked about the knee and kind
of how long that lasts. Is it similar for a hip?
Should we expect similar things of a revision or redo
for a hip surgery?
Speaker 1 (39:23):
Yeah? The plastic part can wear out. You know, most
hip surgeries that we don't use cement, and cement is
one of the things that can wear out in the knee.
There is the ability to do a cementless knee, and
that's something you know, conversation. I don't think we quite
had time for tonight, but to be happy to have
that conversation another time. If you do a cementless knee
that can last forever. There's just a risk of early
(39:46):
failure and the plastic park can wear out. But changing
out the plastic on either a knee or a hip
is a much smaller surgery than having to do bony work. God. Yeah,
either way the part that can wear out.
Speaker 2 (40:00):
And then we have just about you know, thirty seconds left.
But as a gastron trologist, I have this selfish question.
We get asked a lot to give antibiotics to our
patients who are having polonoscopies, either after surgeries. As an
orthopedics with knee or hip. Should patients be asking for
antibiotics for certain procedures?
Speaker 1 (40:21):
You know, if you need the only thing that are
you talking about, like after surgery? Yeah, after surgery, So
the only routine thing you get after surgery that should
need an antibiotic that you don't already get it is
get old cleaning, and that's highly controversial, so we give
it for two years after me or hip repoints.
Speaker 2 (40:40):
For Thank you so much, doctor sweet I mean, I
think you know from all the calls that we've had
just how important this is to people, and we thank
you for being out there and taking care.
Speaker 3 (40:50):
Of our patients with these problems. That's going to do it.
Speaker 2 (40:53):
For tonight's segment of Centered on Health with Baptist Health,
I'm your host, doctor Jeff Tublin. I want to thank
our guest doctor Alex we and our producer mister Jim Benn.
I want to thank David Wallace, Mike and Terry for
calling in added great value to the conversation. And I
hope everybody has a great week the great weekend, and
we'll see you every Thursday.
Speaker 1 (41:27):
This program is for informational purposes only and should not
be relied upon as medical advice. The content of this
program is not intended to be a substitute for professional
medical advice, diagnosis, or treatment. This show is not designed
to replace a physician's medical assessment and medical judgment. Always
seek the advice of your physician with any questions or concerns.
Speaker 3 (41:48):
You may have related to your personal health or regarding
specific medical conditions.
Speaker 1 (41:52):
To find a Baptist health provider, please visit baptistealth dot
com
It's now time for Centered on Hell with Baptists Hell
on use Radio. Wait forty tell many WYJS. Now here's
doctor Jeff Tubblin.
Speaker 2 (00:11):
Good evening and welcome to tonight's episode of Set It
on Hell with Baptist Hell Here on News Radio eight
forty whas. I'm your host, Doctor Jeff Tubblin, and we're
joined as always from the studio by our producer, mister
Jim Fentn. He is waiting for you to call in
and talk to tonight's expert. And our phone number is
five oh two, five seven one eight four eighty four
(00:34):
if you want to call in five oh two, five
seven one eight four eight four. So seven hundred and
ninety thousand total knee replacements are done in the United
States every year, and five hundred and forty four thousand
hit replacements as well, So we're very lucky that our
guest tonight is an expert in both of those surgeries.
So doctor Alex Sweet is joining us tonight. He's an
(00:56):
orthopedic surgeon in Louisville, Kentucky, affiliated with Baptist hig Hospital.
He performs minimally invasive surgery for the knee and the hip,
and he is a wealth of information and experience.
Speaker 3 (01:06):
He has been on our show before. We always learn so.
Speaker 2 (01:10):
Much from from him. Welcome doctor Sweet, and welcome back
to Center on Health.
Speaker 1 (01:15):
Thank you very much for having me.
Speaker 3 (01:17):
Yeah, we love having you.
Speaker 2 (01:19):
It's such a it's such an important surgery that people
have to have and think about. And you know, you
are no stranger to the world of orthopedics, having coming
from a tradition of orthopedic surgeons in near family. So
tell us a little bit, like, my kids want nothing
to do with anything that I went into. So how
did that click for you? What made you want to
follow and become an orthopedic surgeon?
Speaker 1 (01:42):
I think you know, uh, children of physicians and either
goes one of two ways. Either they you know, grow
up loving the idea of being a doctor and that's
the only thing they could ever do, or they grew
up hating it. And you know, some of it's probably
the kid, and some of it's probably a lot of
the mother or father that was the physician. And you know,
(02:02):
first of all, my dad loved his job. You know,
he never worked a day in his life because he
absolutely loved what he did. And second of all, probably
the only thing my dad was better at the knee
and hip surgery was being a father and he was
just always there and always around. And I think just
having that experience and seeing the love he had for
the job, it's what I wanted to do.
Speaker 3 (02:22):
Well, that's a great answer.
Speaker 2 (02:25):
So we're going to try and cover both the hip
and the knee tonight, and we're going to try and
get as much information out of you obviously as we can.
But I want to start with the hip. So tell
us a little bit about the hip and the anatomy
that we might need to understand to know what you're
doing with the replacement and the function, and you know
what the hip is supposed to be doing.
Speaker 1 (02:46):
Sure, So, I mean the hip kind of comes down
to being a ball and socket joint. And what happens
is the cartilage, which is on the end of the
bone on both the ball and on the socket, starts
to wear out over time. And most people think it's
like a wear and tear thing, but honestly, it's more
genetic than anything else. If your mom, dad, grandparents all
(03:07):
had arthritis, you're gonna have it too. And so as
that starts to wear out and the bone underneath starts
to get exposed that has nerve endings and that's painful,
and that's the grinding feeling that people get and it's
what causes all the pain. But centered around the hip
is a bunch of important ligaments, tendons, muscles. There's you know,
(03:28):
a cluster of muscles we call the short external rotators
that kind of help twist your leg in and out.
There's the gluteal muscles, you know, gluteaus maximus, medius minimus
that are kind of your your big butt muscles. Then
there's you know, the hip flexor muscles what allow you
to you know, pick your thigh up, you know, your
your quadrcep muscles. Even so, all these muscles are around
(03:50):
the hip joint and it's it's a deep structure. It's
it's well in between all of these muscles, nerves, tendons, ligaments.
So it's a it's a complex join for sure in
terms of the soft tissue anatomy.
Speaker 2 (04:03):
And how do most people present when they have a
hip issue. Is it like not able to move the hip?
Speaker 1 (04:10):
Is it pain?
Speaker 3 (04:11):
What do you see?
Speaker 1 (04:11):
Most commonly, it's pain with weight bearing and activity. You know,
classically the pain is in the groin kind of in
the what I tell people is front pocket pain is
usually the hip. Back pocket pain is usually your back,
and so that's kind of a rule of thumb. But
certainly not everyone reads the anatomy book, and some people
present differently, but it's usually yeah, pain right in the groin.
Speaker 3 (04:34):
Fantastic.
Speaker 2 (04:35):
Well, I will say I I want to stick with
the hip, but we actually have a caller already, so
I don't want to have him miss the opportunity to
talk to you. So we have got David on the
phone and he has a question about his knee and
kind of having bone on bone, so maybe you can
tell us a little bit about what that means. Also,
but David, you're on Centered on Health with doctor sweet.
Speaker 1 (04:56):
Well, thank you very much. Doctor Peln.
Speaker 4 (04:59):
Yes, I have boom both in my knees, and right
now I'm experiencing a whole lot of pain and I
can't be operated on because they want me to lose
weight and it's very difficult to do and you could
barely walk it in pain. So I've heard about gail treatments,
and I'm wondering, is that the official to someone who
(05:20):
has bone on bone or is that I'm not beyond
that particular kind of treatment.
Speaker 1 (05:26):
So you know, jel's a difficult one to tackle, right
because you know, you see them advertised a lot. You know,
they're on TV, they're everywhere. I mean, truthfully, I gave
a couple of people gel injections today in my clinic.
I am not a big fan of Gael injections, and
I'll tell you why. When we study gel injections, they
(05:50):
do not do very well. And so when we take
you know, a few thousand people and half of them
get a GEL shot and half of them get a
shot of water in their knee, and we don't tell
them which one they're getting, and the person giving the
shot doesn't even know what they're getting it. So that's
called a double blinded trial. That's the best kind of
trial we can do. And when we do that, there's
no difference between the water shot and the jail shot.
(06:13):
So these things are incredibly lucrative. You know, I get
a little you know, with everything, and I get a
little fee for giving the procedure given a shot, but
I make way more off of the gel itself. The
medication is incredibly lucrative, and that's that's the real impetus
behind all the advertisement that you see. So I always
tell people that if I give someone a jail shot,
I'll let them know this, and if they still want
(06:35):
to proceed, I think it's fine. And I think for
some people where they just don't have any other options.
You know, maybe you're overweight, you have a medical issue,
or you're just terrified a surgery and want to try everything.
It's not dangerous and if your insurance will pay for it,
you know, the only risk is you get it and
it doesn't work, which is certainly a lower risk than
having surgery and that not working, there's something going wrong.
(06:55):
So I always respect the patient's autonomy and ability to choose.
But gel shots are not a you know, they're not
something that works on a regular basis for most people.
Speaker 5 (07:06):
Okay, well, thank you very much.
Speaker 1 (07:07):
That was very helpful. I appreciate it very much.
Speaker 3 (07:10):
Yeah, thank you for calling in and being a part
of our show.
Speaker 1 (07:13):
Than before.
Speaker 3 (07:15):
Yeah, have a great have a great rest of your night.
Speaker 2 (07:17):
So, doctor Sweep, before we take a first commercial, let
me just piggyback on that whole topic. This This was
obviously a bone on bone issue, But before somebody gets
to that point, what do you feel about the supplements
out there, conjoint and things like that. Do you use
that or are those things that can help people symptomatically?
Speaker 1 (07:36):
You know, there's never been any evidence to show that
those things work. You know, they're a little for most people,
they're a little expensive out of pocket, you know, Biomechanically,
it doesn't make a whole lot of sense that those
would actually you know, be you know, metabolized and turn
into new cartilage. But another thing that's completely harmless, right,
You're not gonna it's not like a vitamin you're gonna
(07:58):
take too much of. It's not un if it doesn't
have interactions with blood pressure medicines or other medicines. So
it's very safe. And I've got some patients that take
them and swear it works for them. And you know,
just because the studies don't show a difference doesn't mean
it doesn't help a particular population of people. And especially
when it's safe, I think it's always fine to try.
Speaker 2 (08:19):
And when it says bone on bone, how does somebody
get that?
Speaker 3 (08:24):
What leads to a bone on bone? What are we
kind of talking about?
Speaker 1 (08:28):
Well, that just means the cartilage on both ends, either
the hip or the knee, has worn out and so
the bone is just literally grinding on the bone, and
that's usually when the pain starts to worsen. But you know,
I've got patients that get corzone shots or gel shots
or just do physical therapy and live with it and
have had bone on bone for years and do just fine.
Other people gets to be bone on bone becomes debilitating.
(08:50):
So it's more about the patient and their symptoms other
than the actually.
Speaker 2 (08:54):
Fantastic Well, we do have another caller, but I'm going
to ask them to hold on just a little bit
because we're going to take a quick break. We are
talking tonight with doctor Alex Sweet about knee replacements and
hip replacements. This is doctor Jeff Tublin. You are listening
to Senate on Health with Baptist Health here on news
radio eight forty wh as. Our phone number five oh
(09:15):
two five seven one eight four eighty four. That's five
oh two, five seven one eight four eight four. We'll
see you at the break at the end of the break.
(09:42):
Welcome back to Centate It on Health with Baptist Health
here on news radio eight forty WHS. I'm your host,
doctor Jeff Tublin. We're talking tonight with doctor Alex Sweet
about knee replacement surgeries and hip replacement surgeries and any
any questions related to that. Our phone number is five
oh two one four. Our producer, mister Jim Fenn is
(10:04):
already taking and ready to take your calls. So welcome back,
doctor Sweet. We've got several callers who are ready to
hear your expertise, and we're gonna start with the first one.
We have Warren on the phone. Who Wallace on the phone,
who is asking a question about a knee replacement Wallece,
are you with us?
Speaker 5 (10:24):
Yes? Thank you doctors. Uh yeah, I've Brett injured my
knee like thirty eight years ago and now it has
severe tried compartmental arthritis with the big ol'd Baker syst
But I've been missing a ligament all that time, interior cruciate.
When and if I had the total knee replacement or
(10:45):
would any surgeon consider trying to do something with that
missing ligament to add stability? Are there any options during
knee replacement to address still missing ACL?
Speaker 1 (11:01):
So so here here's the truth about new arthritis. Even
if you hadn't torn your ACL, when you get really
bad ne arthritis, your ACL is usually torn. Anyways, or
kind of non functional knee replacement designs. Almost all of them,
We're talking about ninety nine point nine percent of the
ones put in the United States and Europe. They are
(11:22):
all designed to not have an ACL. So when I
do my knee replacements, I cut out the ACL. So, uh,
it is a structure that actually gets in the way.
You end up cementing the tibia implant right over top
of where the ACL and search. So that is a
fortunately for you, a complete non factor.
Speaker 5 (11:41):
Okay, what about a Baker says that you have to
kind of live with that.
Speaker 1 (11:46):
So a Baker's syst is a symptom, it's not actually
the problem. What happens is the knee is is basically
a water balloon, right, it holds the oil in that
lubricates the knee. And if the knee keeps swelling up
because it's painful and arthritic, that fluid has to go
somewhere and the weak spots in the back so it
kind of creates this out poushing back there called a
Baker cyst. So when you replace the knee, yeah, you
(12:08):
still got a Baker's syst. I mean, your knee is
big and swollen, it's painful, could just add surgery and
as it starts to heal, and as there's no more
reason for the knee to swell, that Baker's cyst resolves
on its own.
Speaker 5 (12:21):
Okay, well, thank you so much.
Speaker 2 (12:24):
Well, thank you thanks for being a part of the show.
And if Mike is still on the line, then Mike
has a question for you, I switching gears into the
hip about different types of hip surgery. Mike, are you
on the line, yes, wonderful, Well, welcome to Senate on
Hell and you have doctor sweet.
Speaker 1 (12:43):
Hey.
Speaker 6 (12:44):
Is it true that you prefer the anterior approach for
the hip versus the posterior approach for patient outcome and recovery?
Speaker 1 (12:54):
I do you know, there's been a lot of studies
on this. It's basically been shown that the anterior hip
has a quicker recovery, you know, long term. Is there
a big difference? Not really. Probably the biggest difference is
the anterior hip has a little bit lower dislocation rate
where the ball will not pop out of the socket
(13:16):
to the same degree. You know, a lot of surgeons
there's a learning curve to learning it, and so like
I learned the anterior hip in my residence, so I
kind of started day one with it, but when it
was becoming popular, some surgeons didn't want to switch over,
and like my father never switched over. He did, you know,
post your hip to the end of his career. It's
(13:36):
just a little bit different of a surgery. You have
to detach some tendons, you're cutting through your biggest gluteal muscle,
and so the recovery is a little bit tougher because
of that. Okay, thank you, thanks thanks for calling in.
Speaker 2 (13:52):
So since we've been doing a little bit of knee stuff,
I want to ask you a couple of questions that
actually got submitted to me. The first one is, if
you're seeing a rise in knee injuries in younger athletes
with some of the use of these more synthetic feels
and artificial turf, Is that like a real thing? Are
(14:13):
you seeing more injuries because of that?
Speaker 1 (14:16):
So I'll be honest, I am not, because I mean
the joke is I'm kind of a geriatric orthopedis right.
I mean, you know, I see forty fifty year olds
with arthritis, but I'm not seeing the college athlete out
on the synthetic turf because if they tear their acl
I don't fix that. You know, I'm a knee and
hip replacement specialist, and so if they tear their ACL
(14:37):
thirty years later, they may need my services, but for
now they're going to my partners. But there are absolutely
some synthetic turfs that have been shown to increase the
rate of LIGAMENTUS, knee injuries and other injuries.
Speaker 2 (14:51):
Great, and we have another caller on the line, which
is Terry. If Terry is with us, Terry, are you
on the line?
Speaker 3 (14:58):
Yes, I am, well, Welcome to the show.
Speaker 2 (15:01):
Welcome to Centered on Health. You have a doctor, sweet
and it sounds like you have a question about a hip, right.
Speaker 7 (15:09):
I wondered somebody told me that I had pain in
my hips, and I was worried it was going to
be a replacement situation. But then somebody said it could
be birthsidas. And I just want to ask the doctor
what are the symptoms of versidis because mine is sort
of on the side and it goes down to where
you know, the I call them the saddle bags on
(15:31):
your legs are Yeah, does if any help for me
on that?
Speaker 1 (15:37):
Sure? So you know, trying to diagnosis over the phone.
If you made me pick, I'll tell you that probably
is presidas, so I kind of said earlier. Hip arthritis
is front pocket pain. Back pocket pain is back pain,
usually pain on the side of the hip, right on
the side. That's usually presidas. Now sometimes also means tendon itis.
But what it is a non operative issue and a
(15:59):
lot of times the zone shot in there or some
physical therapy can help you a lot.
Speaker 7 (16:05):
Where should I go for a court of zone shot?
Should I go to an orthopeutic person?
Speaker 1 (16:09):
Or yeah? Probably tomorrow morning. So I'm happy to see
you and take Carrie.
Speaker 7 (16:18):
Okay, and how do you spell your last name? I'm
sorry I couldn't understand it.
Speaker 1 (16:23):
S W E E t oh.
Speaker 7 (16:26):
Okay, that's sweet?
Speaker 1 (16:27):
All right, easy enough, right, Yeah, you're very sweet.
Speaker 2 (16:32):
Bye, Terry, thank you for calling and thanks for being
a part of the show.
Speaker 3 (16:36):
And good luck.
Speaker 2 (16:36):
Sounds like hopefully we may be able to avoid surgery
for you. That's great.
Speaker 1 (16:41):
I've had your status before. It hurts.
Speaker 2 (16:43):
Yeah, it is painful. Well, hopefully a COURTI zone shot
will will help. Uh so, doctor sweet. There was some
news this week about one of the women n C
double A athletes, Juju Watkins, who j A C L
And I mean it was such a such an unfortunate thing.
Can you can you tell us is there a difference
(17:03):
in injury to what female athletes and male athletes. Is
the anatomy different. I had read a couple of things
that suggested that, yeah.
Speaker 1 (17:13):
There is some truth to it. So actually, when I
was in my residency, my chief year, my one of
my co residents, she actually studied this and back when
she was in med school and was did a presentation
on it. There's a lot of difference. There's there's some
anatomic differences based on anatomy of the pelvis. Actually, women
(17:35):
have slightly different pelvises, which means their femur or their
thigh bone comes in in a different angle. And because
of that angle, it changes the angle of the knee
where the where the shin bone meets the femur bone.
There's also differences in the strength of the quatercep versus
the hamstring, and women tend to have a little bit
(17:55):
of dominance of their quadtercep over the hamstring, and that
and that, and it's can actually lead to injury during
landing in a higher rate of ACL pairs. So that
that was the data on this about you know, ten
years ago. Now there may have been something to change.
But again, as a knee replacement surgeon, that's not you know,
the focus of my career. But there is a real difference.
Speaker 2 (18:18):
Wow, that's that's that's fascinating. So you mentioned a little
bit about the cortisone injection, and just to kind of
you know, round out that that advice. How often can
somebody get a steroid injection? Is there like a limit
on how much steroid you can give somebody in terms
of an injection or is there a certain frequency that's allowed.
(18:40):
What what do you see and how how long do
they need to get it typically for it to be effective.
Speaker 1 (18:46):
When we're talking about like joint pain, you know, there's
no real limitation. I mean, sometimes you're talking about something
in the hand or foot and ankles, sometimes there's limitations.
You can have one or two and that's it. But
if you're talking about just ne arthritis, hip arthritis is
getting core zone injections or preside us, there's no limit.
I mean the limit it ends when when it is
no longer effective in the treatment. And so eventually the
(19:10):
disease gets bad enough that the corizone shot just doesn't
work or doesn't last very long, and then you've got
to consider surgery at that point, and you can get
it every three months.
Speaker 3 (19:21):
Every three months, well, that's good.
Speaker 2 (19:24):
And then when you how do you advise people to decide,
you know, hey, I think it's time I need surgery, Like,
what's that? What's the tipping point that either you typically
see patients come to or a patient might be thinking
at home. I've tried this, I've tried that, maybe I
really need to think about having surgery, you.
Speaker 1 (19:44):
Know, except in rare circumstances where sometimes patients need some reassurance.
My goal is to never talk someone into a surgery, right,
So I tell them they will know, and that's the truth.
And you know, I get multiple people coming into my
office every day that says that say, either myself or
my dad or someone else told them they were going
to need a knee replacement and they would know, and
(20:05):
they go, I know, I'm ready, and then we have
the conversation. You know, eventually it starts inhibiting your life,
and it depends on what that is. I mean, some
people right now pickleballs in Some people say, you know,
I'm get in these court zone shots. I can't play pickleball.
I love pickleball. I want to keep playing on what
my neighborplace other people. I can't even get to the mailbox.
My knee is so bad. I'm in a wheelchair and
(20:25):
now I'm ready. And so it's individual rights. It's not
certain metrics for certain people. It's you got to treat
the patient holistically, not just you know, a spreadsheet of
what you can and can't do.
Speaker 2 (20:39):
And when a patient is evaluating a surgeon, what's a
good number for a year of someone doing these that
somebody should be looking for to say, hey, you know this,
this practitioner does a lot of these, And is there
a number per year that you think makes somebody kind
of more in that expert area.
Speaker 1 (21:01):
I think if you're I think if you're doing you know,
two to three hundred neighbor replacements a year, you're in
kind of that higher you start to begin be getting
into that higher volume category where it's it's been shown
in the literature that the complication rates are lower, patient
satisfaction scores are higher. So that's the number I usually
give people somewhere between two and three hundred a year.
Speaker 2 (21:21):
Fantastic, Well, we are learning all about me and hip
surgery tonight. We are talking with doctor Alex Sweet. We're
going to take a quick break here. I want to
remind everybody that you are listening to Centered on Health
with Doctor's Health here on news Radio eight forty whas.
I'm your host, doctor Jeff Tublin, and our phone number
is five oh two, five seven one, eight four eight
(21:42):
four if you want to call in and there's still
time to ask questions, we'll be right back. LL welcome
(22:02):
back everyone to Center It on Health with Doctor's Health
here on news Radio eight forty whas. I'm your host,
doctor Jeff Tublin. And if you aren't just joining us,
we are talking tonight with doctor Alex Sweet, who is
an orthopedic surgeon here in Louisville with specialties in both
knee and hip. And we've been answering lots of great
questions and picking his brain with a lot of great questions.
Speaker 3 (22:25):
So I do want to take a moment.
Speaker 2 (22:28):
Doctor Sweet, to focus a little specifically on the knee
and your practice, because I know that you are our
next generation of orthopedic surgeons and are using a lot
of newer techniques with your surgeries. Talk to us a
little bit about especially since you have the perspective with
your Dad, How have things evolved and what are you
(22:49):
doing that's kind of unique with knees.
Speaker 1 (22:54):
Yeah, So I think as technology keeps evolving, we keep
finding ways to bring it into healthcare and improve outcomes.
You know, the knee replacement kind of traditionally we you know,
it's more of like instead of a replacement, think of
it as resurfacing where you're just cutting a little bit
of the bone and cartilage up the end and capping
it with some metal and there's a plastic shin that
(23:16):
goes in between. And so traditionally the angles of the
cut just kind of get determined by your bone, by
your femur and your tiviot. But the problem is what
really matters are your ligaments. How tight your ligament on
the inside your MCL, how loose the ligament on the
outside your LCL is And in some people it's the
it's vice versa. The relationship is switched. And you can
(23:39):
gain some insight into that based on preoperative X ray
or MRI, but you can't know until you get in
the knee. And so what we used to do is
cut the bone, put in the implants, and then kind
of cut the ligaments to match what we did to
the knee and it works. Okay, it does, but it's
it's not a perfect surgery. And so with the ad
(24:00):
of robotics, what we're now able to do is before
we cut any bone, we can actually tension the ligaments,
find out exactly how much give and take they all have,
and then design the implant to go in the perfect
orientation to match your ligaments. So we're not talking about
some huge difference. We're talking about one, two, three degrees here,
(24:20):
you know, half a millimeters millimeter there. But the clinical
difference is monumental in terms of not having to release
the ligaments at all. And so robotics is changing knee
replacement quickly.
Speaker 2 (24:35):
And the advantage of the ligament thing is that you
don't have to cut them, or their healing is faster,
or what is the clinical advantage there?
Speaker 1 (24:45):
So a it's a better long term result because when
you balance the knee appropriately, patients have less instability, less pain,
faster recovery, and the long term outcome is better. You know,
if you put a knee in just you know, at
ninety degrees to the bone and throw a piece of
plastic in there, the knee is going to wobble around
a fair amount, and it's going to lead to increased
(25:07):
pain and patient dissatisfaction. You know, traditionally knee replacements can
have up to twenty percent patient dissatisfaction score. There's a
lot of things that lead to that, but one of
the things that we're using to combat that is robotics
and it's made a huge den Well that's great.
Speaker 2 (25:24):
And do you see things coming down the line. Are
we kind of at our peak with it or do
you see things changing even in the next five to
ten years.
Speaker 1 (25:34):
Oh? No, I think we're continuing to evolve. I mean
I'm starting to use some augmented reality with the surgery
to help interface with the robot, you know, to kind
of overlay it over the patient and make that process
a little more seamless. So no, I mean technology is
always changing, and you know, I always want to make
sure we're not just bringing unnecessary technology in that it's safe,
(25:55):
that there's a reason to do it and not just
to you know, for the next shiny tour way. But no,
there there are clear advancements in technology that are that
are benefiting surgeries.
Speaker 2 (26:08):
That's fantastic. And how long does need replacement? Last is
do you get one and your good or is there
a life expectancy where someone might have to have it
done again.
Speaker 1 (26:20):
Yeah, with everything, there's a life expectancy. I tell my
patients it's a car tire, and it depends on the
size of the car, and it depends on the speed
of the car. You know, Grandma's olds will bile is
going to last a whole lot longer than you know,
fifty year old's Ferrari. And so depending on the wear
and tear you put on it, you can wear it
out either the cement that bonds it, the plastic in between.
(26:43):
Something can wear out over time. You know, the rule
of thumb we give people is twenty years. The stuff
we're using now is better. In twenty years from now,
we'll know how it's how well it's lasting. But at
least twenty.
Speaker 2 (26:54):
Plus years, I mean that's yeah, that's a good amount
of time. And when when some one has a knee replacement,
how do you tell them to expect that they're going
to feel in terms of their ability to do things?
Is the expectation that they will be like they were
before their knee ever gave them problems? Or can they
(27:16):
tell that they have a knee replacement by like hearing
it or feeling it, Like how do you have the
conversation about what life with the knee replacement will be?
Speaker 1 (27:24):
Like part of that depends on what the patient's expectations
are and you kind of have to delve down into
what they do. Are they looking to get back to
playing full court basketball? Are they looking to be able
to you know, get to you know, Friday afternoon, you know,
par cheesy with their friends and not have any knee pain.
And once you find out what the expectations are, you
can really tailor it to them. I mean, you know,
(27:46):
for the higher demand patients, patients wanted to get back
to basketball, tennis, you know, walk the golf course. You know.
I tell them it's never going to be in need.
That feels like you're twenty years old again. It's always
going to be replaced. It's always going to be a
little bit foreign. But it shouldn't give you any pain
and it should allow you to do all the things
you want to do without pain. And that's the big thing.
Speaker 3 (28:08):
And how long is the surgery?
Speaker 2 (28:11):
How long is the hospital stay? And when do you
get them starting on rehab?
Speaker 1 (28:20):
So the surgery is you know, an hour a little less,
little more, just kind of depends on the patient and everything.
But the surgery time a little less than an hour
a hospital. Say, you know, some patients are a candidate
to go home the same day, Some need to stay
at night, some patients still need to go to rehab
for a little while. In terms of getting them up,
(28:41):
once their eyes are open, it's time to get to work.
It's immediate. You know, we get them up right away,
get them working with physical therapy. You know, they can
have home therapy for a week or two, then sooner
you get the outpatient therapy, the better. Your home does
not have a pet department, and so you need all
the equipment. We're getting extra special exercise bikes delivered to
(29:01):
the house. Talking about technology, these are special engineered exercise
bikes where the pedals kind of barely moved and they
start moving more and more. I get multiple patients a
day telling me what an awesome piece of equipment it is,
and it really is. Got an interactive screen kind of
walks them through how to do everything. So it's an
(29:21):
immediate go, go go. In terms of getting to the.
Speaker 2 (29:24):
Rehab and what's a typical rehab program, I'm sure it
varies from person to person based on their progress, but
on average, how long does it take for people to
be through the physical therapy and then kind of be
out on their own again.
Speaker 1 (29:40):
You know, first three weeks are tough. It's not an
easy surgery. And everyone that's going through it has a
friend or someone that's gone through it and they tell
them that, so they come in knowing that those first
few weeks they're really tough and there's a reason we
get pain medicine for it. And once they get through that,
it gets a whole lot better. You know, by six
eight weeks you should be getting around pretty well. We
call it three months to recover. But the biggest key
(30:02):
to being happy with your need is understanding even at
three months, you're not as good as you're gonna get.
And it takes about a year for the need to
feel as natural and normal as it's going to. And
not that you can't get out and do stuff and
you can't get back to golf or you can't get
back to these things, but it's just it's not as
good as it will be.
Speaker 2 (30:20):
Well, I can appreciate two things that you said there.
I mean one is and they're both really about expectations,
And I think, you know, the way you describe the
healing process is really important because you know, I think
we all know people that have these done and just
like you said, they think they're going to be back
to doing things immediately, and if they're not, that that
means that they won't continue to get to get better.
Speaker 3 (30:41):
So that's that's great.
Speaker 2 (30:44):
What do you see, like, are there things that we
should be doing in our lives before our neees become
a problem that might keep us out of the operating room?
Speaker 1 (30:56):
You know, you really can't prevent arthritis like the disease itself.
You know, staying active. The old adage motion is lotion
is really important. You know, people to become debilitated have
way more pain. You know, when your quad step and
your muscles are on the legs start getting weak, it
hurts more. The other thing is your knee sees three
(31:18):
times your body weight when you walk, five times when
you do the stairs, and seven times when you squat,
So if you get it from a chair, your body's
seeing seven times your body weight. And if you're three
hundred pounds and you're supposed to be two hundred, that
means that's seven hundred pounds each knee is seeing extra
when you get up from the seat of position, so.
Speaker 2 (31:36):
That that's a big deal. That is an interesting perspective. Yes, well,
let's take our final break here. We're going to get
back to hips when we come back, and we'll remind
everybody that you are listening to Centered on Health with
Baptis Health here on news radio eight forty whas. We're
talking tonight with doctor Alex Sweet, orthopedic surgeon here in Louisville,
(31:58):
about hip and knee replacement. And if you've missed any
part of tonight's show or you want to hear all
this information, download the iHeartRadio app. It's free, it's easy
to use, and it gives you access to all of
tonight's information.
Speaker 3 (32:10):
We'll be right back.
Speaker 2 (32:24):
Welcome back to Centered on Help with Baptist Help here
on news radio eight forty WATS. I'm your host, doctor
Jeff Tomlin, and we're talking tonight with doctor Alex Sweet,
who's an orthopedic surgeon here in Louisville. He's talking to
us about knee replacements and hip replacements. Remember to download
the iHeartRadio app to re listen to this or any
of our previous segments and to have access to all
(32:46):
the other features that they have app cuts to offer. So,
Doctor Sweet, I've been trying to get back to the
hip and I'm going to do it. So I want
to hear a little bit about the hip. Earlier on
in the show when we first started talking about the hippie,
we're talking about out a ball and socket, and could
you just expand on that and tell us a little
bit about what is actually getting replaced in a hip replacement.
Speaker 1 (33:10):
Sure, So when we do the surgery, we actually remove
the ball and so the ball is attached to the
femur or your thigh bone. And right after we kind
of get the ball out of the way, we look
up into the cup and we have these circular reamers
that basically bore out a perfectly circular hole in that cup,
(33:30):
just expand it by a millimeter or two, and then
we put a metallic cup up into the into the socket,
and usually we'll use a you know, a forty five
millimeter reamer and then a forty six millimeter cup and
the cup kind of wedges in because it's one millimeter larger,
and then there's a plastic liner that then snaps into
(33:51):
that metal cup and at that point you're done with
the cup side. Now on the femur, there's a stem
that goes down into the thigh bone, and so we
actually have to make room for that. You know, the
the bone bone is is hollow. On the outside is
the hard cortical bone, and on the inside is this
softer can sell us bone. And we kind of have
(34:13):
to dig that softer bone out so that the implant
rests right on the harder bone. That way, it doesn't
you know, slip down or what we call subside or
slip down the femur, because when we put it in,
we want it to be we want it to stay
at that same place and not move. And so we've
got all these devices that kind of, you know, remove
that bone little by little, and you keep going up
on the size until you get one that fits perfectly
(34:36):
on the on the cortex of the bone. And then
there's different trials where you can change the length of
the ball in its relationship to the stem so that
you can equalize the leg length to kind of dial
it in perfectly. And one of the reasons I love
the interior hip is I can bring in an X
ray get a perfect a perfect X ray and measure
those leg links and make sure we're bound it in perfectly.
(34:58):
And then you put the real femur part in with
the real ball. You pop it back in, get a bilelectray,
make sure it looks good. And that's kind of what's
being replaced. The nice thing with the anterior hip. I
don't have to detach a single ligament and I don't
have to be touch a sea. I don't have to
cut a single muscle. I can literally take my finger
and dissect between the muscles bluntly and get down to
(35:19):
the hip castle.
Speaker 3 (35:21):
And does that that decreases pain or recovery or both both?
Speaker 1 (35:27):
Yeah, a little a little bit less pain. I mean,
hip replacements typically not a very painful surgery, especially when
you compare it to a knee, but it absolutely helps
with the recovery time more than anything. Got it?
Speaker 3 (35:40):
And what is the term like a partial hip replacement?
What does that mean?
Speaker 1 (35:46):
So you know there's partial knees, there's partial hips. Partial
knees a great surgery for a young, active individual with
archritis and part of their knee. A partial hip is
something that gets done by essentially a non joints someone
that does not typically perform hip replacements like full hip
replacements when someone breaks their hip, So a partial is
(36:08):
not something we do for elective hip arthritis. It's done
for someone that falls down, breaks their hip and needs surgery.
You know, typically when that happens and I'm on call,
or the patient that ends up in my hands, I'll
do a full hip replacement. But some of my patients,
some of my colleagues that you know are more adept
at ACL surgery and not so much knee and hip replacement,
(36:29):
will do a partial hip and those patients still do
very well with that.
Speaker 2 (36:34):
And you know, I'm assuming, you know, other than trauma,
which obviously would have you know, potentially only affect one side.
Do most people, if they get problems in their hip,
get them in both hips and ultimately need both hips replaced?
Or do you find that some people just get arthritis
in one hip and they never have a problem with
the other hip.
Speaker 1 (36:56):
It tends to run in both. They don't always, you know,
not everyone comes in with both hips being in stage
our frights. Sometimes it's just one and then years later
it's the other. I can't tell you how many patients
I've replaced one of their hips and my Dad replaced
their other hip ten fifteen, twenty years ago, so it's
incredibly variable when they present, but if you live long enough,
(37:20):
it tends eventually get there.
Speaker 3 (37:22):
If you have it in one, you'll probably have it
in the other.
Speaker 1 (37:25):
Yes, got it.
Speaker 2 (37:27):
And we've talked a lot about rehab, which I think
most people are familiar with, but there's been this concept
of sort of prehab. Is that something that you use
in your practice, sending people for strengthening and stuff before
the surgery, and what's the thought behind that process?
Speaker 1 (37:45):
So I love it. I love the idea of it.
The idea of prehab is essentially going to physical therapy
before the surgery to strengthen yourself up. Well that help
with your postof recovery. Absolutely. Probably the biggest issue is
how many physical therapy appointments you get in the calendar years.
So it's a limitation of physical therapy. And so if
(38:08):
if you're about to the knee replacement, your insurance says
you're gonna have fifteen physical therapy appointments and you use
six of them before surgery, you're gonna you're gonna be
struggling afterwards. You're either gonna have to pay out of pocket,
or you're gonna have to do it on your own,
and that's hard. So it's great when I talk about patients, Yeah,
if I'm gonna if they're gonna do it, I'll usually
tell them, hey, go once, learn the exercises and do
(38:30):
them on your own so you don't run out of therapy.
Speaker 3 (38:33):
Oh, that's that's great advice.
Speaker 2 (38:35):
And then also I think people hear a lot about
like platelet rich plasma. Is that something I know we've
talked about it before, and I've talked to other guests
on the show that you know, sometimes it helps before surgery,
maybe not, But are you using it as part of
your surgery?
Speaker 1 (38:54):
I am not. It's a complete out of pocket expense
with absolutely no literature to suppor it for knee and
hip arthritis. There's some limited evidence in other fields, but
in terms of the knee and hip, there's no real
evidence that it helps. And I just I don't want
to charge my patients that kind of money for that.
Speaker 2 (39:11):
Great And then you talked about the knee and kind
of how long that lasts. Is it similar for a hip?
Should we expect similar things of a revision or redo
for a hip surgery?
Speaker 1 (39:23):
Yeah? The plastic part can wear out. You know, most
hip surgeries that we don't use cement, and cement is
one of the things that can wear out in the knee.
There is the ability to do a cementless knee, and
that's something you know, conversation. I don't think we quite
had time for tonight, but to be happy to have
that conversation another time. If you do a cementless knee
that can last forever. There's just a risk of early
(39:46):
failure and the plastic park can wear out. But changing
out the plastic on either a knee or a hip
is a much smaller surgery than having to do bony work. God. Yeah,
either way the part that can wear out.
Speaker 2 (40:00):
And then we have just about you know, thirty seconds left.
But as a gastron trologist, I have this selfish question.
We get asked a lot to give antibiotics to our
patients who are having polonoscopies, either after surgeries. As an
orthopedics with knee or hip. Should patients be asking for
antibiotics for certain procedures?
Speaker 1 (40:21):
You know, if you need the only thing that are
you talking about, like after surgery? Yeah, after surgery, So
the only routine thing you get after surgery that should
need an antibiotic that you don't already get it is
get old cleaning, and that's highly controversial, so we give
it for two years after me or hip repoints.
Speaker 2 (40:40):
For Thank you so much, doctor sweet I mean, I
think you know from all the calls that we've had
just how important this is to people, and we thank
you for being out there and taking care.
Speaker 3 (40:50):
Of our patients with these problems. That's going to do it.
Speaker 2 (40:53):
For tonight's segment of Centered on Health with Baptist Health,
I'm your host, doctor Jeff Tublin. I want to thank
our guest doctor Alex we and our producer mister Jim Benn.
I want to thank David Wallace, Mike and Terry for
calling in added great value to the conversation. And I
hope everybody has a great week the great weekend, and
we'll see you every Thursday.
Speaker 1 (41:27):
This program is for informational purposes only and should not
be relied upon as medical advice. The content of this
program is not intended to be a substitute for professional
medical advice, diagnosis, or treatment. This show is not designed
to replace a physician's medical assessment and medical judgment. Always
seek the advice of your physician with any questions or concerns.
Speaker 3 (41:48):
You may have related to your personal health or regarding
specific medical conditions.
Speaker 1 (41:52):
To find a Baptist health provider, please visit baptistealth dot
com
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